Otolaryngology Coding Alert

Question: I have been cross-referencing the size of excised lesions noted in the op report with the size noted in the pathology report and am confused that they are often different sizes. Which measurement should I use for coding?

New York Subscriber

Answer: You should always choose a code based on the size in the physician's documentation, not the size documented in the pathology report. One reason not to code from the pathology report is the specimen generally will shrink in formalin, sometimes to half its original size, which would mean you under-code and cost your otolaryngologist deserved reimbursement.

On the other hand, coding elliptical excisions from the pathology report can cause you to make the opposite mistake: over-coding. Because of the elliptical shape, the size documented in the pathology report might be the specimen size, not the lesion size, and therefore might be a lot larger than the actual lesion and its margins. Thus, coding from the pathology report could lead to overpayment and could also put you on the watch list with your payer and even the Office of Inspector General.

Example: The physician excises a benign lesion from the patient's nose. The lesion measures 2 cm at its widest. To ensure removal of all malignancy, the physician allows a margin of at least 1.5 cm on all sides. In addition, the physician slightly lengthens the margins at two ends to allow the wound to heal with a less obvious scar.

To calculate the excised diameter, you should begin with the size of the lesion (2 cm) and add the width of the narrowest margin multiplied by 2 (1.5 x 2, or 3 cm total) for a total of 5 cm (2 + 3 = 5). In this case, you should report 11446 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm).